Management Tools

I. INTRODUCTION
This position is located in a health care facility of the Indian
Health Service. The purpose of this position is to interpret, analyze,
and assign diagnostic and procedural codes. The coding function
provides the primary source for data and information used in health
care, promotes continuity of medical care, and ensures compliance
with third party reimbursement policies, regulations and accreditation
guidelines.

II. MAJOR DUTIES

1. Performs quantitative analysis by reviewing records to assure
the presence of all component parts such as patient and record
identification, signatures and dates where required, and the presence
of all reports which appear to be indicated by the treatment rendered.

Performs qualitative analysis by evaluating the record for
documentation consistency and adequacy. Ensures that the final
diagnosis accurately reflects the care and treatment rendered.
Reviews the records for compliance with established third party
reimbursement agencies and special screening criteria.

Makes the final determination that medico-legal requirements
of the record is complete, accurate, and reflects sufficient data
to justify the diagnosis and warrant treatment and end results.

Identifies inconsistencies, discrepancies and/or trends within
the medical record and discusses with the appropriate medical,
nursing, or healthcare providers, and recommends appropriate modifications
to include medical necessity under the Correct Coding Initiative.

Assigns and sequences a variety of codes including but not
limited to I C D / C P T / H C P C S codes based on the medical
record analysis. Assures the final diagnoses and operative procedures
as documented by the provider are valid and complete. When multiple
diagnoses and procedures are listed, assures the procedure is related
to the proper diagnosis.

Analyzes and abstracts information from the medical record
to identify secondary complications and co-morbid conditions to
assure appropriate assignment under the Diagnostic Related Group
(D R G), Ambulatory Patient Classification (A P C) systems and
other alternate resources.

Provides ongoing education, updates and briefings for the medical
staff, business office staff, and other health care providers on
changing coding conventions, rules, regulations and guidelines.

Performs audits in accordance with the facility Compliance
plan and Performance Improvement study designs, which may include
findings from provider documentation trends, coding peer reviews,
and reimbursement denials. Provides reports of findings and feedback
to parties involved.

Assists in development and modification of facility coding
policies and procedures.

Maintains record confidentiality in accordance with the Privacy
Act of 1974, Alcohol and Drug Abuse Patient Records, Freedom of
Information Act and other pertinent federal regulations.

May perform other duties as assigned.

III. F E S FACTORS

Factor 1. Knowledge required by the Position F L 1-4 550 points

Thorough knowledge of medical terminology, abbreviations,
techniques and surgical procedures; anatomy and physiology; major
disease processes; pharmacology; and the metric system to identify
specific clinical findings, to support existing diagnoses, or substantiate
listing additional diagnoses in the medical record.

Extensive knowledge of official coding conventions and
rules established by the American Medical Association (A M A),
and the Health Care Finance Administration (H C F A) for assignment
of diagnostic and procedural codes.

Skill in operating computerized data entry and information
processing systems. Skill in data collection to compile and organize
information for reporting and presentation.

Basic knowledge of Performance Improvement methodology
to track, trend, recommend resolutions, and report on status of
adverse or quality service.

Oral communication skills to conduct briefings and training
classes.

Writing skills sufficient to prepare reports and other
materials.

Factor 2. Supervisory Controls F L 2-3 275 points
The supervisor defines the overall goals and priorities and is
available for guidance with unusual problems. The supervisor relies
upon the coder’s knowledge, skills, and abilities to independently
perform his/her assignments. The Coder initiates and follows through
with assignments using established policies, instructions, and
accepted practices in Health Information Management. The Supervisor
periodically reviews the work for results, technical accuracy and
conformity to Health Information Management policy and regulatory
requirements.

Factor 3. Guidelines F L 3-3 275 points.
Guidelines include numerous facility policies; accrediting standards
(for example, J C A H O, A A A H C); Federal and State laws, regulations,
and policies; Indian Health Service policies and established health
information procedures. Guides are general and do not cover all
areas encountered in work performed such as cases involving new
diseases, treatments, terminology or drugs. The Coder uses considerable
judgement in adapting and interpreting the general guidelines for
application to specific cases to decide the most appropriate course
of action to take. This includes devising new procedures, adapting
to new computer technology, and instituting coding and analysis
changes.

Factor 4. Complexity F L 4-3 150 points
The Coder makes decisions regarding the proper assignment and
sequencing of diagnoses and procedure codes by interpreting and
analyzing a variety of medical documentation from different sources.
Decisions involve choosing alternatives when standard procedures do not address
the situation and may involve contacting staff in other administrative and
clinical departments to achieve acceptable solutions. This work involves analyzing
and interpreting conditions and elements to correct complicated inconsistencies
or discrepancies in the record.

Factor 5. Scope and Effect F L 5-3 150 points
Work involves performance of a variety of specialized analysis
and coding functions that provide the primary source of data and
information used in health care. The incumbent performs a variety
of duties that directly impact the accuracy, documentation, timeliness
and reliability of health information management services. The
work impacts facility accreditation, quality of patient care, reliability
of research data, appropriate levels of third-party reimbursement,
Government Performance Results Act (G P R A) and O R Y X performance
indicators.

Factor 6/7. Personal Contacts/Purpose Contacts F L 2B 75 points
Contacts are with physicians, nursing staff, business office staff,
employees within the immediate organization or work unit, and representatives
of various outside state and federal agencies such as Third Party
Fiscal Intermediaries and State Peer Review Organizations (P R
O). The purpose of the contacts is to exchange factual information
and to coordinate work efforts and solve technical and policy problems.

Factor 8. Physical Demands F L 8-1 5 points
The work is primarily sedentary. There may be some walking or
carrying of light items such as manuals or files. Good eye/hand
coordination is required.

Factor 9. Work Environment F L 9-1 5 points
The work environment involves risks and discomforts of a patient
care setting including exposure to communicable diseases, working
with office machines and computers. The demand of computer terminals
and keyboards for long periods of time may cause eye, shoulder
and wrist strain. Work is performed in a smoke free office setting.
There is adequate light, heat, and ventilation in work area.

Total points = 1485=G S-7

IV. OTHER SIGNIFICANT FACTORS:
May be required to work rotating shifts, evening, nights, weekends,
and holidays.